Treating Low Self Esteem (LSE) With CBT

June 29, 2012 in Psychotherapy

Although low self esteem (LSE) is in itself not a psychiatric diagnosis, it has been associated with and cited as an etiological factor in a number of conditions. LSE has also been shown to predict poorer outcome in psychological treatments, as borne out by tests such as CORE-OM (Clinical Outcomes in Routine Evaluation – Outcome Measure), besides increasing the possibility of relapse. The nature of relationship between LSE and psychiatric conditions is unclear. While some studies have shown that knowledge that one has a psychiatric disorder may lower self esteem, other studies have given evidence that a lowered self-esteem may make one predisposed to a range of psychiatric illnesses, leading to the suggestion that LSE and psychiatric illnesses may have a recursive relationship. It may thus be surmised that working on ameliorating self esteem may potentially improve the outcome of a number of psychiatric treatments.

A team of researchers from Reading and Oxford, UK, conducted a preliminary randomized controlled trial (RCT) of CBT using LSE, on a sample population of 22 participants, with a presenting problem of a range of Axis I disorders, such as  social anxiety disorder, major depressive disorder, generalized anxiety disorder, body dysmorphic disorder, OCD, PTSD, dysthymic disorder, and the like. The participants were randomly allocated to two groups – one called the “Immediate Treatment” (IT) group (n=11) and the other called the “Wait List” (WL) group (n=11). The members of both the groups were individually administered CBT treatment for a period of ten weeks each, on an out-patient basis. The WL group participants received treatment once their waiting list period – lasting 10 weeks – was completed, and they formed the control group. A followup assessment was conducted 10 weeks after CBT administration.

The treatment itself was based on Fennell’s cognitive conceptualization and transdiagnostic approach, consisting of 10 sessions, each lasting an hour. The treatment comprised four phases:

1. In the first two sessions, the researchers formulated and set goals for individual participants and provided them with psycho-educational training.

2. In the next five sessions, the participants were introduced to skills for re-evaluation of anxious and self-critical thoughts and beliefs with the help of cognitive techniques and behavioral experiments.

3. In the next five sessions, the participants underwent positive self-acceptance and self-affirmation.

4. Finally, in the next four sessions, participants were oriented in the skill of developing more adaptive beliefs and rules. Future sessions were tailor-designed for each participant.

The participants were also given a three-part self-help workbook and were asked to read the chapters & complete the exercises to tie in with the associated therapy sessions.

Post treatment, the team found a clinically significant change in the participants, as measured on the RSCQ scale (Robson Self Concept Questionnaire), with greater improvement in self-esteem, anxiety, depression and general functioning concomitant with a reduction in psychiatric diagnoses, in comparison to the WL cases. Further, this gain was found to have been stable at the time of another assessment conducted 11 weeks after the CBT administration.

Thus, Fennell’s protocol was found to give positive results in treatment of cases of low self esteem. The team also recorded the limitations of the study, viz its small sample size, population recruited comprising mainly educated females, and the availability of only one therapist to administer the intervention. What makes the study significant is that the participants had a variety of psychiatric diagnoses, and the CBT using Fennell’s protocol yielded positive results on the RSCQ scale for all the cases. 



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